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       What is Dialysis?
       Residual Renal Function
          The Importance of RRF
       Diabetes Management
          PD and the Diabetic Patient
          General Facts: Diabetes
          When to Initiate PD in the Diabetic Patient
       Renal Osteodystrophy
          Renal Osteodystrophy Clinical Studies
       Numbers-Their Use and Interpretation
       Basic Statistics
       History of Sorbent Technology
       Vaccinating CKD and Dialysis Patients
Peritoneal Dialysis
       History of PD
          PD - The Foundations
          Early Clinical Experiences with PD
       Basic Principles of PD
          Anatomy of the Peritoneum
          Physiology of the Peritoneum
       Peritoneal Transport 
          Understanding Testing Methods
          Transport Status:Classification and Implications
          Peritoneal Function After Exposure to PD
       Modalities of Therapy
          PD Techniques
          PD Modalities
       PD Adequacy
          Prescribing Dialysis
             Targets of PD Prescription
             Determinants of Dose
             Exchange Volume and Position
             How to Reach the Goals
             Monitoring the PD Patient
             Evaluating the Patient as a Whole
             StdKt/V - Dose Equivalency
       Ultrafiltration
          Importance of Volume Control
          How to Achieve Adequate PD UF
       Clinical Procedures
       Complications
          Non-Infectious Complications of PD
          Peritoneal Dialysis-Related Infections
             Management of ESI
             Diagnosis and Treatment of Peritonitis 
       Dialysis Access
          The Evolution of PD Catheters
          Preop Management
          Placement of PD Catheters
          Intraoperative Management
          Post Operative Care and Management
          Complications of PD Catheters
       Clinical Outcomes
          Clinical outcomes of PD and HD
       PD Training Materials 
Hemodialysis
       History of Hemodialysis
       Kinetic Principles
          Impact of t & Kr on Kt/V
          StdKt/V - Dose Equivalency
       Modalities of Therapy
          Hemodialysis Regimens/Prescriptions
          Extracorporeal Modalities
       Home HD
          Introduction
          HD Regimens/Prescriptions
          The Influence of Dose, Time & Frequency
          Every other day HD (HD3.5)
          Time Versus Dialysis-Free Interval
          Benefits of Increased HD Frequency
          Increased Frequency – Other Modalities
          Potential Lifestyle Benefits of HD3.5
          Home Program Management
             Establishing a Home Program
       Intradialytic Complications
       Adequacy
          Difficulties in Prescribing Adequate Dialysis
       Sodium Modeling
       Hemodialysis Access
          Introduction to Vascular Access
          Overview of Arteriovenous Fistula
          Overview of Arteriovenous Grafts
          Overview of Central Venous Catheters
          Vascular Access Monitoring and Surveillance
       Access Complications
          Overview of Hemodialysis Complications
          AVF Stenosis
          Interventions for AVF and AVG Stenosis
          Primary Fistula Failure
          Catheter Related Bacteremia
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Glossary



A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z



AAMI
Association for the Advancement of Medical Instrumentation that develops voluntary standards for aspects of dialysis, including water treatment and dialyzer reprocessing.

Acid Clean
Pertaining to a hemodialysis system: A daily process where acid (vinegar) is rinsed through the acid and bicarbonate lines.

Acidosis
A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate) content of the blood and body tissues, and characterized by an increase in hydrogen ion concentration (decrease in pH).

Acute
Rapidly developing; severe; short duration.

Acute Renal Failure

A sudden loss of kidney function; it can be reversible.

Air Embolism
Occurs when air bubbles enter the bloodstream and are carried into a vessel small enough to be blocked by the air, where it acts like a clot, blocking the flow of blood.

Alkalosis
A pathological condition resulting from accumulation of bicarbonate and is characterized by a decrease in hydrogen ion concentration and increase in pH.

Allergic Reaction
Local or general hypersensitivity reaction following contact with a specific allergen.

Ambulatory
Moving or walking around.

Anaphylaxis

Anaphylaxis or anaphylactic reaction is an immediate, severe reaction to a substance to which an individual is allergic. The reaction may include signs and/or symptoms such as hives, itching or wheezing. The reaction may develop into anaphylactic shock, which can cause life-threatening consequences such as hypotension, cardiac arrhythmias or arrest, spasms of the breathing passages and swelling of the throat.

Anemia

A deficiency of the oxygen carrying pigment of hemglobin often accompanied by a reduced number of circulating red blood cells; common in patients on dialysis due to decreased red blood cell production and procedural blood loss. The major symptoms are fatigue, tiredness, breathlessness on exertion, pallor and poor resistance to infection.

Anticoagulant
Substance that delays or prevents coagulation of blood.

Antiseptic

A chemical which prevents or inhibits growth and reproduction of bacteria; it does not necessarily destroy them as a disinfectant would.

Anuric

Absence of urine formation.

Arrhythmia
Irregular heart beat, rapid or slow pulse, palpitations caused by changes in the blood pH or electrolyte levels (potassium), hypotension or heart disease.

Arterial Drip Chamber
Chamber within the hemodialysis system extracorporeal circuit were arterial pressure is monitored.  A bubble trap inside the drip chamber collects any air that enters the blood tubing.

Arterial line
Part of the hemodialysis system extracorporeal circuit that is involved with transporting the patient’s blood to the dialyzer.

Arterial Side of Dialyzer
The end of the dialyzer where the patient’s blood enters to be dialyzed.

Aseptic

Free from infectious organisms; sterile.

Aseptic Technique

A process of rendering an object completely free of microorganisms. A method usually involving sterile gloves, gowns and masks.

Assisted PD
The administration of peritoneal dialysis (PD) modalities to a physically dependent patient by a home-visiting nurse, a caregiver or a family member.

Auto Flow Rate
A ratio of dialysate flow to blood flow based on the dialysis prescription, for example 2x dialysate auto flow with a blood flow of 400ml/min would be 800 ml/min.

Automated PD (APD)
A number of different PD modalities that use an automated peritoneal dialysis (PD) machine.

Automated PD machine
An electrical appliance specifically designed to perform peritoneal dialysis (PD) automatically, also known as a "cycler".

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B


Back Pain
Pain or discomfort located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions.

Bacteria
Single cell organisms, fully capable of rapid reproduction. They are prevalent everywhere; some are harmless, others known to produce infectious diseases.

Bicarbonate
A buffer used by the body to neutralize acids that form when the body breaks down protein and other foods. 

Biocompatibility
The quality of not having toxic or injurious effects on biological systems.

Biocompatible PD solutions
Peritoneal dialysis (PD) solutions with characteristics like low GDP concentration, near neutral pH, low concentration of lactate buffer (some biocompatible solutions use bicarbonate as a buffer and others use a mixture of bicarbonate and low lactate concentrate).

Blood Circuit
Component of the hemodialysis system that is enclosed within the arterial blood line, dialyzer fibers and the venous blood line. It is also referred to as the extracorporeal circuit.

Blood Flow Rate
See blood pump speed.

Blood Leak Detector
An alarm system that monitors used dialysate for blood or air that would indicate a leak in the dialyzer membrane.

Blood Line Set
Part of the extracorporeal circuit that carries blood from the patient’s vascular access through the arterial needle or catheter port, to the dialyzer, and back to the patient through the venous needles or catheter port.  There are two segments of blood tubing: arterial (red connector colored) and the venous (blue connector colored).  Other components of the blood tubing include patient connectors, dialyzer connectors, arterial and venous drip chambers, blood pump segment, heparin and saline infusion lines.

Blood Pressure

The pressure exerted against vessel walls resulting from the pumping force of the heart and resistance of blood vessels. It is measured by auscultating (listening to) the changing sounds produced by varying external pressures on an artery.

Blood Protein

A complex substance or very large nitrogen containing molecule found in blood.

Blood Pump
Part of the hemodialysis delivery system that moves the patient’s blood through the extracorporeal circuit at a fixed rate of speed when the blood pump segment is threaded between the pump head and the rollers.

Blood Pump Door
Cover of the blood pump.

Blood Pump Housing
Component of the hemodialysis machine that holds the blood pump rotor and tubing guides.

Blood Pump Speed
Prescribed rate of blood programmed on the blood pump.

Body Mass Index (BMI)

Anthropometric index defined as weight in kilograms/(stature in m2)2.

Bolus
A relatively large, single dose.

BUN (Blood Urea Nitrogen)
Nitrogen in the blood in the form of urea. It is a result of protein breakdown due to dietary intake (digestion) or inherent bodily tissue breakdown. An increase usually indicates decreased kidney function.

Bypass Mode
Bypass mode occurs when the dialysate conductivity or temperature goes outside alarm limits.  In bypass mode, valves inside the hemodialysis machine redirect the flow of dialysate to bypass the dialyzer internally until temperature and conductivity are back within acceptable limits.

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C

Cardiac Tamponade
A pathological condition which results from excess accumulation of fluid in the pericardium.

Catheter

A tubular, flexible instrument, passed through body channels for withdrawal of fluids from (or introduction of fluids into) a body cavity.

Catheter extension
A piece of tubing connecting the catheter to the peritoneal dialysis (PD) delivery system.

Catheter-related peritonitis (or exit site- or tunnel infection-related peritonitis)
A peritonitis episode in conjunction with an exit-site or tunnel infection with the same organism as that at the exit site.

Chemoreceptor

A sense organ or sensory nerve ending that is stimulated by and reacts to certain chemical stimuli. It is located outside of the central nervous system.

Chemical Rinse
The “Chemical/Rinse program of the hemodialysis machine disinfects the machine by rinsing it with water, chemical disinfectant, and water again. 

Chest Pain
Pressure, burning, or numbness in the chest.

Chronic

Of long duration or recurring frequently.

Chronic Kidney Disease

Persistent, long-lasting renal pathologic process, often associated with loss of kidney function.

Chronic Renal Failure

The progressive, irreversible loss of kidney function that occurs over periods of time ranging from a few months to decades. Also called Chronic Renal Insufficiency.

Clean Technique

Rendering an object partially free from organisms.

Clean Technique
Series of steps necessary to prevent contamination of patient or environment. It includes, but is not limited to, using clean gloves and hand washing.

Clearance

A quantitative measure, expressed in mL/minute, of the rate at which waste products are removed from the blood by the kidney, peritoneal membrane or artificial kidney.

Clot

A mass of coagulated blood. The normal reaction of the blood to a damaged blood vessel or foreign material.

Coagulation

The process of forming a blood clot.

Coefficient

A numerical measure of a physical or chemical property that is constant for a system under specified conditions.

Concentrate
Pertaining to hemodialysis: One of two salt solutions (acid and bicarbonate) that are mixed together with purified water to form dialysate.

Conductivity
The ability of a fluid to transfer electrical charge as a measurement of ions in a solution.

Conductivity Meter
Measures the electrolyte composition of dialysate to ensure it is within safe limits for use.

Connecting device
A device of different designs (exclusively specific for each peritoneal dialysis (PD) delivery system) used for the connection of the catheter or its extension to the delivery sytem. Synonym to connector.

Contaminate

To make unclean, unsterile or impure.

Continuous ambulatory peritoneal dialysis (CAPD)
A peritoneal dialysis (PD) modality where a certain amount of dialysate is always present in the peritoneal cavity resulting in a continuous dialysis method. Four daily exchanges are typically performed manually using gravity or in some cases with the use of an assisting device.

Continuous cycling peritoneal dialysis (CCPD)
An automated PD (APD) modality with a number of exchanges during the night and a long daytime dwell. All exchanges are performed by a cycler.

Continuous cycling peritoneal dialysis plus or enhanced(CCPD plus or enhanced CCPD)
Continuous cycling peritoneal dialysis (CCPD) with the addition of at least one daytime manual exchange.

Continuous flow peritoneal dialysis(CFPD)
A peritoneal dialysis (PD) modality where dialysate flows continuously in and out of the peritoneal cavity through two separate catheters or one dual lumen catheter.

Contraindication
Symptom, condition or circumstance that renders the use or a remedy or procedure inadvisable, usually because of a risk.

Convulsion
Violent involuntary contraction or series of contractions of voluntary muscles. Also known as seizure.

Corrosive
Slow disintegration or wearing away of something by a destructive agent.

Cramping
During the hemodialysis treatment: Painful muscle cramps often in the hands and feet resulting from removal of too much fluid, changes in blood chemistry, especially sodium, low potassium levels and hypotension.

Creatinine

Creatinine is a waste product of creatinine phosphate metabolism, which is found especially in the muscle and blood. Increased creatinine values in the blood can be an indication of renal failure. It is one of the primary lab values indicating a patient's need to start dialysis.

Crenation
Conversion of normally round red blood cells into shriveled, irregularly shaped forms that occurs if the blood is exposed to a solution that is more concentrated than blood.

Culture negative peritonitis
The appearance of cloudy effluent (with more than 50% polymorphonuclear white blood cells) and abdominal pain with persistently (>3) negative cultures of peritoneal effluent.

Cycle

A peritoneal cycle or exchange is the infusion and drainage of a specific volume of peritoneal dialysis solution consistent with the PD prescription. The PD prescription defines the volume, dwell time and sometimes the rate of infusion and drainage. The dwell time may vary from a few minutes to several hours.

Cycler

A machine used to infuse and drain dialysate from the peritoneal cavity.

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D

Dehydration
Excessive water loss from the body, organ or bodily part. This occurs when output of water exceeds intake.

Dextrose (Glucose)
A form of sugar used in dialysate to remove fluid.

Dialysate (dialysis fluid)

A mixture of water, electrolytes and dextrose. Sodium lactate is the most commonly used buffer in the dialysis solution. Newer solutions using pure bicarbonate or bicarbonate/lactate combinations have been developed as a more physiological buffer. Electrolyte levels in dialysate are proportioned to ensure that the levels in the blood remain within physiological range. Waste products, such as BUN and creatinine are not present in the dialysate and will readily move out of the blood into the dialysis fluid.

Dialysate Circuit
Component of the dialysis system that is enclosed within the hydraulic system and the dialysate compartment (outside the fibers) of the dialyzer.

Dialysate container
In peritoneal dialysis: The bag containing the dialysate, also known as the “peritoneal dialysis bag”.

Dialysate Flow Rate
A prescribed ml/min flow of the dialysate through the dialyzer.

Dialysate fresh
The unused dialysate

Dialysate leak (peritoneal)
Extravasation of the fluid to any space outside the peritoneal cavity (e.g. pleural cavity, through the exit site or the surgical incision, scrotum).

Dialysate spent
The dialysate drained out after its dwell in the peritoneal cavity, also known as effluent.

Dialysis

Diffusion of blood across a semi-permeable membrane to remove toxic substances. Dialysis maintains fluid, electrolyte and acid-base balance when there is impaired kidney function or there are no native kidneys.

Dialyzer Reaction
Can be caused by a reaction to ethylene oxide with symptoms occurring in the first 15 – 30 minutes of treatment that include itching, chest and or back pain, shortness of breath, hypotension, nausea and general discomfort.

Diastolic Blood Pressure

The blood pressure against the arteries when the heart is at rest (between beats). It is the bottom half of the blood pressure reading.

Diffusion

Process in which solutes move from an area of high solute concentration through a semi-permeable membrane to an area of low solute concentration.

Disequilibrium Syndrome
Can occur when the BUN is removed much faster from the blood than from the brain, when disequilibrium occurs, fluid moves into the brain cells and potential symptoms are headache, nausea, hypertension, restlessness, confusion, blurred vision and seizures. 

Disinfectant

Chemical that destroys bacterial-organisms.

Distal

Refers to furthest from the center of the body. For example, the hands and feet are distal extremities. The opposite of proximal.

Diurnal PD or daytime PD
A number of manual exchanges during the day with a dry abdomen during the night (for those who need short exchanges and for whatever reason cannot or will not use a cycler).

Drain (of PD fluid)
The action of outflow of the spent dialysate from the peritoneal cavity.

Drain Time
The amount of time needed for the peritoneal fluid to drain from the peritoneal cavity.

Drip Chamber
Used to collect air in the arterial and venous chambers of the hemodialysis system.

Dry Weight

The ideal body weight without excess fluid volume.

Dwell
The period during which the dialysate remains inside the peritoneal cavity (usually from the end of the infusion to the beginning of drainage).

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E

Edema
Accumulation of an excessive amount of fluid in or around tissues or cells.

Effective peritoneal surface area
The area of the peritoneal surface that is sufficiently close to peritoneal capillaries to play a role in solute and water transport.

Efferent
Carrying away from the central organs or section. For example, efferent arterioles carry blood away from the glomeruli of the kidney. The opposite of afferent.

Effluent

The used or spent dialysate fluid that is carried to the drain.

Electrolytes

An electrolyte is a compound that breaks apart into ions. Common electrolytes include sodium (Na+), potassium (K+) and calcium (Ca++). Electrolytes transport electrical impulses along the nerves to the muscles, including the heart. Healthy kidneys maintain electrolyte balance in the body. Electrolytes are added to dialysate in carefully controlled amounts.

Embolus

A mass of undissolved matter present in the blood or lymph brought there by the blood or lymph current.

Encapsulating peritoneal sclerosis (former term: Sclerosing encapsulating peritonitis)
A life threatening complication of peritoneal dialysis where an encapsulating sclerotic reaction of the peritoneum develops, with the bowel enveloped in a thick cocoon of fibrous tissue, causing intermittent,partial, or complete bowel obstruction.

Endotoxin

A poison harmful to all body tissues, contained within certain Gram negative bacteria and released only when the bacterial cell is broken down or dies and disintegrates.

End Stage Renal Disease

Term used for complete or irreversible loss of kidney function, the last stage of chronic renal failure. Also referred to as ESRD.

Enteric peritonitis
Infectious peritonitis with an organism consistent with those from the gastrointestinal tract. (Presence of anaerobic organisms is pathognomic of this condition).

Equilibrium

The body's attempt to maintain balance or homeostasis. Used in reference to equal concentrations in two compartments across a semipermeable membrane.

Erythropoietin

A hormone that acts on the bone marrow to stimulate red blood cell production. It is produced by the kidney in response to oxygen deficiency in the tissues.

Estimated Dry Weight

The weight the patient would be if the kidneys functioned normally.

Etiology

The cause of a disease.

Exchange

A peritoneal exchange or cycle is the infusion and drainage of a specific volume of peritoneal dialysis solution consistent with the PD prescription. The PD prescription defines the volume, dwell time and sometimes the rate of infusion and drainage. The dwell time may vary from a few minutes to several hours.

Exit site
The most external part of the sinus tract and the skin surrounding the exit of the catheter tunnel. Usually the location of the exit site is in the abdominal wall, but a presternal exit site is also an option.

Exit-site infection
Evidence of inflammation (pain, swelling, erythema, and/or discharge) at the exit site.

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F

Febrile
Body temperature greater than 98.6F or 37.0C.

Fibrin

A whitish filamentous protein formed by the action of thrombin on fibrinogen.

Fill
Term used in peritoneal dialysis to indicate the action of inflow of the fresh dialysate from its container into the peritoneal cavity.

Filtration
Process of a stream of liquid moving through a partition with small holes. Fluid and particles small enough to pass through the partition will, while larger particles will remain.

Flush
Peritoneal flush or lavage is the "rapid" infusion and drainage of peritoneal dialysis solution with the purpose of removing blood, fibrin, debris or spent dialysate from the peritoneal cavity or catheter. The dwelltime is minimal or non-existent. Or, in terms of the actual exchange procedure itself, to flush is to remove the remaining air from the infusion line into the drainage bag.

Fluid Overload
State of the patient when dry weight has not been reached, this can lead to congestive heart failure or pulmonary edema.

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G

Glomerular Filtration Rate (GFR)

The volume of plasma filtered from the glomerular capillaries into the Bowman's capsule each minute (mL/min).

Glomerulus

A cluster of capillary blood vessels that act as a filter in the nephron.

Glucose degradation products (GDPs)
Products resulting from the degradation (break down) of glucose during heat sterilization of the dialysate, which are believed to be toxic to the peritoneal membrane. Glucose can bind in a non-enzymatic way to amino residues forming a Schiff base and later a reversible Amadori glycosylation product.  These products undergo rearrangements over time and form irreversible advanced glycation end products (AGEs), which may play a role in the development of peritoneal fibrosis and microvascular sclerosis, observed in long term PD patients. Formation of GDP can be significantly reduced by the use of multi-chamber bag systems2

Gram
The basic unit of weight measure in the metric system. There are approximately thirty grams in one ounce.

Gross peritoneal surface area
The anatomical surface area of the peritoneal membrane lining the peritoneal cavity.

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H

Hand Crank
Relating to the hemodialysis machine:  Method used to return blood to the patient during a power failure, also know as Emergency Hand Crank, that utilizes the auxiliary blood pump crank handle inserted into the hand crank spindle on the blood pump and the blood is manually returned to the patient.

Headache
Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions.

Hemastix
Monitoring strip that identifies the presence of blood.

Hematocrit
A measurement of red cells in the blood, stated as a percentage of red blood cells per total blood volume.

Hematoma

An accumulation of blood that has escaped into the tissues from blood vessels. It is commonly referred to as a bruise and appears "black and blue".

Hemodialysis

A process of removing chemical substances and water from the blood by passing it through an artificial kidney composed of semi-permeable membranes.

Hemoglobin

Protein found in erthrocytes that transports oxygen in the blood.

Hemolysis

The destruction of red blood cells resulting in the liberation of haemoglobin, potassium and other cell contents.

Hemorrhage

Abnormal bleeding, either internal or external.

Heparin

A powerful anticoagulant that blocks/suppresses clotting of the blood. In peritoneal dialysis heparin can be added to the dialysis solution. Heparin inhibits the formation of fibrin and may prevent subsequent adhesion formation.

Heparin Pump
A component of the hemodialysis delivery system that delivers heparin at a prescribed rate.

Hepatitis

An inflammation of the liver, can be of viral or toxic origin.

Homeostasis

State of equilibrium of the internal environment of the body that is maintained by dynamic processes of feedback and regulation.

Hydrostatic Pressure

The pressure exerted by a column of water due to gravity or mechanical pressure.

Hyperkalaemia

Unusually high levels of potassium in the blood.

Hyperparathroidism
Primary hyperparathyroidism is a disorder of the parathyroid glands, also called parathyroids. "Primary" means this disorder originates in the parathyroids: One or more enlarged, overactive parathyroid glands secretes too much parathyroid hormone (PTH). In secondary hyperparathyroidism, a problem such as kidney failure causes the parathyroids to be overactive.

Hypertension

Blood pressure greater than normal.

Hyperthermia
Abnormally high body temperature.

Hypertrophy

An increase in size of an organ or structure that does not involve tumor formation.

Hypervolemia
Abnormally increased volume of circulating blood in the body.

Hypokalaemia

Not enough potassium in the blood.

Hypotension

Low blood pressure.

Hypoperfusion

Decreased blood flow through an organ, as in circulatory shock. If prolonged, it may result in permanent cellular dysfunction and death.

Hypothermia
Abnormally low body temperature.

Hypotonic

A solution with an osmolality or concentration of solutes less than that which it is compared. In dialysis, the fluid of comparison is usually blood.

Hypovolemia
Abnormally decreased volume of circulating blood in the body.

Hypoxia
Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen.

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I

Icodextrin
Usually a 20 glucose polymer molecule which is used as an agent inducing ultrafiltration by oncotic pressure. [From the Greek word for twenty: eicosi or ico(si) + dextrin = icodextrin].

Infection
Invasion of the body by disease producing organisms and the reaction of the tissues to their presence.

Infiltration
In hemodialysis, this is referred to as the dislodgment of the fistula needle from the patient’s access which results in blood being returned to the surrounding tissues.

Inflow time
The time needed for the fresh dialysate to enter the peritoneal cavity.

Intermittent peritoneal dialysis (IPD)
IPD generally consists of frequent, short cycles performed over 8 - 10 hours per session, three times weekly. The peritoneal cavity remains drained between sessions. If IPD is practiced on a nightly basis, it is referred to as nocturnal IPD (NIPD). See home page “peritoneal dialysis-modalities”.

Intraperitoneal Volume (Vip)

The volume of fluid inside the peritoneal cavity.

Isotonic

A solution with an osmolality or concentration of solutes equal to that which it is compared. In dialysis, the fluid of comparison is usually blood.

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K

Kilogram
1,000 grams; 2.2 pounds.

Kt/V
The Kt/V concept was introduced by Gotch and Sargent to quantitate dialysis dose and represents the product of urea clearance (K) and dialysis time (t) divided by the volume of distribution of urea or total body water (V)3.  Kt/V is different in hemodialysis (HD) compared to peritoneal dialysis (PD).  In HD, Kt/V relates to a single dialysis session, whereas in PD Kt/V relates to an entire week.

KUF
In vivo ultrafiltration constant.  The fixed amount of fluid a dialyzer will remove from the patient’s blood per hour at a specified pressure. A dialyzer’s KUF is included with its instructions.

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L

Lavage
Peritoneal lavage or flush is the "rapid" infusion and drainage of peritoneal dialysis solution with the purpose of removing blood, fibrin, debris or spent dialysate from the peritoneal cavity or catheter. The dwell time is minimal or non-existent.

Luer lock
A type of tubing connector with threaded fittings for a secure connection and added leverage for a seal disconnect. The concept for these adapters was developed by Hermann Wulfing Luer, a German medical instrument maker whose name still defines this unique design.

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M

Mass transfer area coefficient (MTAC)
For a given solute, MTAC is equivalent to the diffusive clearance of that solute per time unit in a theorectical situation where dialysate flow in infinitely high, so that the solute gradient is always maximal (MTAC is analogous to K0A of a hemodialysis membrane and is best assessed at the beginning of each exchange when there is maximum difference in the concentration between blood and dialysate)

Macrophage

A large scavenger cell present in connective tissue and many major organs and tissues including the bone marrow, spleen, lymph nodes, liver and central nervous cells.

Membrane

A thin layer of tissue that covers or surrounds a surface or space. In dialysis,it can refer to either the peritoneal membrane or the material out of which the internal fibres of the artificial kidney are composed.

Membrane failure
The inability of the peritoneal membrane to maintain adequate ultrafiltration or adequate solute clearance.

Metabolism

The sum of all physical and chemical changes that take place within an organism. All energy and material transformations that occur within living cells.

Modality
A means or manner in which a procedure is attained.

Molecule
Smallest particle of a substance with distinct chemical properties that identify the substance; stable group of atoms.

Morbidity
Pertaining to disease or illness.

Mortality

Pertaining to death or loss of life.

Myalgia

Tenderness or pain in the muscles.

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N

Nausea
An unpleasant sensation in the stomach usually accompanied by the urge to vomit.

Nephritis

Inflammation of the kidney. A disease of the kidneys haematuria associated with a nephritic syndrome that includes hematuria as its distinguishing component. Other classic symptoms include hypertension, renal insufficiency, volume overload, oedema, and in some cases, proteinuria.

Nephrologist

A physician who specializes in kidney diseases and their treatment.

Nephron

The structural and functional unit of the kidney. It consists of a glomerulus enclosed within Bowman's capsule and its attached tubule (consists of proximal convoluted tubule, loop of Henle and distal convoluted tubule). Urine is formed by filtration in the glomerulus, and selective reabsorption and secretion by cells of the renal tubule.

Net sieving coefficient
The fraction of extracellular solute volume removed per unit of ultrafiltrate volume.

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O

Occlude

To shut or close off.

Oedema
Excess fluid in the body tissues; swelling of the body due to excess fluid.

Oliguria
Decreased amount of urine formation.

Osmolality

The osmotic concentration characteristic of a solution that is determined by the ionic concentration of the dissolved substance per unit of solvent.

Osmolarity

The concentration of osmotically active particles in solution.

Osmosis

Passage of fluid through a semi-permeable membrane from an area of lesser concentration to an area of greater concentration in order to achieve equilibrium of solute.

Osteitis Fibrosa Cystica

Tissue level lesions, fibrosis of the marrow spaces and abundance of osteoclasts. Is characterized by severely increased bone resorption and high levels of parathyroid hormone (PTH).

Outcome

End product or result.

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P

Palpable

Perceptible to touch.

Palpitation

Irregular beating of the heart.

Pericarditis

Inflammation of the pericardium, or sac surrounding the heart.

Pericardial Effusion

Fluid in the pericardial cavity, between the visceral and parietal pericardium. It may produce symptoms of cardiac tamponade (see above for definition).

Peritoneal catheter cuff
A band of fabric (e.g. Dacron) affixed to the intratunnel part of the catheter leading to pericatheter fibrous tissue growth. Usually, peritoneal catheters have two cuffs, one located close to the endoabdominal fascia (deep or epiperitoneal or inner or internal cuff) and the other located close to the skin (outer or subcutaneous or superficial or external cuff).

Peritoneal catheter tunnel
The passageway through the abdominal wall within which the peritoneal catheter is contained.

Peritoneal dialysis catheter
See catheter. The intraperitoneal and the extraperitoneal potions differ in various catheters. The most commonly used type of catheter is the Tenckhoff catheter (straight, coiled, or swan-neck design). Modifications of the Tenckhoff catheter are the Missouri swan-neck catheter, the Moncrief-Popovich swan-neck catheter and the Toronto Western Hospital (TWH) or Oreopoulos-Zellerman catheter.

Peritoneal dialysis connectology
A conventional term referring to the various systems of transfer sets, connecting devices, containers, adapters, etc., which are used during the process of peritoneal dialysis.

Peritoneal dialysis dose
The amount of dialysate used in a specified time. It can be numerically expressed by Kt/V or creatinine clearance and should be corrected to either the total body water or body surface area.

Peritoneal dialysis prescription
The combination of peritoneal dialysis modality, dose and schedule.

Peritoneal dialysis (PD) training
The procedure of preparing an individual with ESRD for the self administration of the PD treatment, including preparation of materials, aseptic technique, prevention of contamination, exit site care, performing exchanges, troubleshooting, record keeping, and ordering supplies. PD training is usually provided by a specially trained nurse.

Peritoneal eosinophilia (Former term: Eosinophilic peritonitis)
Asymptomatic cloudy effluent with more than 15% eosinophils in a differential WBC count. It usually appears in the first few months after starting PD and is usually a benign self-limiting condition. (Peritoneal eosinophilia can also occur later during some fungal infections).

Peritoneal equilibration test (PET)
See http://www.advancedrenaleducation.com/PeritonealDialysis/PeritonealTransport/UnderstandingTestingMethods/tabid/80/Default.aspx.

Peritoneal sclerosis
The extensive thickening of the peritoneal membrane due to fibrous tissue and new vessel formation, usually as a result of long-term PD, especially when the latter is complicated by severe or recurrent peritonitis.

Peritonitis

Peritonitis is an inflammation of the peritoneum. Infectious peritonitis is inflammation of the peritoneum related to microorganisms. Resistant or refractory peritonitis is an episode that does not respond to treatment within 48 hours. Relapsing peritonitis is an episode that initially responds to treatment but then symptoms reappear. Recurrent peritonitis is an episode with symptoms that return within 2 weeks of the completion of therapy for peritonitis and the organism is the same as in the prior episode.

pH
The hydrogen ion concentration of a solution.  A solution with a pH above 7 is alkaline (base).  A solution with a pH below 7 is an acid.

Phosphate Binder

Compounds that bind phosphorus in the GI tract, preventing absorption. Bound phosphorus becomes part of the faeces and is eliminated. Classes of binders include aluminum, calcium and magnesium as well as non-absorbable calcium and aluminum-free compounds.

Phosphorus
Is a nonmetallic element present in such foods as dairy products, meats, fish, nuts, chocolate and cola.  Too much phosphorus in the blood can cause itching, secondary hyperparathroidism and bone disease.

Plasma

The straw coloured, non-cellular liquid portion of the blood containing clotting factors. It consists of water, electrolytes, nutrients and proteins.

Polyglucose
Mixture of glucose polymers in different chain lengths.

Pore

Small opening or hole.

Postural Hypotension

The development of hypotension when the posture is changed. This is usually manifested by dizziness on standing.

Potassium
A metallic element, and an important electrolyte in the human body,  Levels of potassium that are too high or too low can cause illness or death, levels must be kept within very tight limits.

Prescription
Directions written for the preparation and administration of a therapy.

Prime
Procedure done before hemodialysis to remove air from the extracorporeal circuit by flushing the bloodlines and dialyzer with saline.

Protein

A group of nitrogen-containing compounds found widely in nature in both plants and animals. They are formed from complex combinations of amino acids. They form structural material of muscles, tissues and organs. They form enzymes and hormones.

Proximal

Nearest the point of attachment, centre of the body or point of reference. Opposite of distal.

Pruritis

Intense itching.

Pulmonary Oedema

An accumulation of fluid in the lungs caused by fluid overload.

Pulse

Rhythmical throbbing caused by the regular expansion and contraction of an artery.

PVC

Abbreviation for polyvinyl chloride

Pyrogen

A substance that causes fever.

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R

Recurrent peritonitis
A peritonitis episode that occurs within 4 weeks of completion of therapy of a prior episode but with a different organism.

Red Blood Cell (RBC)

Cells in the blood stream that carry oxygen in a complete molecule called haemoglobin.

Refractory peritonitis
Failure of the effluent to clear after 5 days of appropriate antibiotic therapy

Regimen

A regimen is a systematic plan of therapy that is generally characterized as intermittent or continuous when referring to the duration of dialysis, and supine or ambulatory when referring to the position of the patient (for PD).

Relapsing peritonitis

A peritonitis episode that occurs within 4 weeks of completion of therapy of a prior episode of peritonitis with the same organism or a prior sterile episode.

Renal
Pertaining to the kidneys.

Renal Osteodystrophy

Generalized bone disease resulting from metabolic disorder caused by renal failure.

Repeat peritonitis
A peritonitis episode that occurs more than 4 weeks after completion of therapy of a prior episode with the same or different organism.

Restless Leg Syndrome
Is a condition that is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso.

Reverse Osmosis (RO)

A method for purifying water by forcing it through a semi-permeable membrane that prevents the passage of ions.

Rinse Back Volume
Amount of saline required to rinse the patient’s blood back following completion of the hemodialysis treatment.

Rotor
The rotating part of an electronic or mechanical device.

Rx
Abbreviation for "Prescription".

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S

Semi-permeable Membrane

A membrane with pores that are permeable to some (smaller molecules) but not to larger molecules.

Sequential Dialysis
Two-stage form of hemodialysis treatment in which the first stage consists only of ultrafiltration.  In the first stage, there is no dialysate flow while the ultrafiltration pump draws excess fluid from the patient.  After the calculated amount of fluid has been drawn, usually a standard dialysis treatment, begins.

Shock

Extreme hypotension.

Sphygmomanometer

An instrument used to measure blood pressure.

Sodium
Chief cation of the extracellular body fluids. Its salts are the most widely used in medicine.  Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance.

Solute

The substance that is dissolved in a liquid (solvent) to form a solution.

Standard Kt/V

The stdKt/V is a formula to measure the relative efficiency of the whole spectrum of dialytic therapies whether intermittent, continuous or mixed.  This method allows the measurement of clearance efficiency of HD of variable frequency, continuous PD, intermittent PD, slow continuous renal replacement therapies (CRRT), residual renal function (RRF) and all situations involving the use of clearance from various methods.

Steal Syndrome
Pain or weak pulse in affected limb caused by shunting of normal arterial blood supply through the access thus depriving distal extremity of needed oxygenation.

Sterile
Completely free from living microorganisms.

Sterile peritonitis
Synonym to culture-negative peritonitis

Stethoscope

A device used to auscultate (listen to) sounds produced by the body. It consists of rubber tubing connecting two ear pieces to a diaphragm and/or bell.

Supine position

Lying with the face upward, or on the dorsalsurface.

Syringe
Instrument used for injecting or withdrawing fluids.

Systolic Blood Pressure

This is the pressure inside arteries during a heartbeat. This is the top half of the blood pressure reading.

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T

Tachycardia

An abnormally fast heart rate. If 70 to 90 beats per minute is considered normal, then 100 beats per minute would indicate tachycardia.

Technique

A technique is the procedure by which a regimen is accomplished.  These definitions can be confusing since similar terms are applied to the regimen and the technique.

Technique failure rate
The proportion of peritoneal dialysis patients switching to hemodialysis

Three-pore model
A theoretical model describing solute and water transport across the peritoneal membrane
Proposing the presence of three different sizes of pores. The smallest are considered to be the aquaporins.

Tetany
A set of symptoms which include intermittent tonic spasms, nervousness and muscular irritability induced by changes in calcium or pH.

Thrombus

Clot formed in a blood vessel or blood passage.

Tidal peritoneal dialysis
See http://www.advancedrenaleducation.com/PeritonealDialysis/ModalitiesofTherapy/PDModalities/tabid/83/Default.aspx

Titanium (or plastic) adaptor
The Luer lock adaptor made of titanium (or plastic), connecting the catheter to its extension or to the administration set of a double-bag system.

TMP (Transmembrane Pressure)
The difference in pressure between the filtrate and permeate sides of the dialyzer membrane.  TMP = Venous Pressure – Dialysate Pressure.

Transducer
An electronic sensor in the hemodialysis  machine that reads the pressure inside the arterial and venous drip chambers.  Transducers are connected to the drip chambers through pressure monitor lines.

Transfer set
The tubing connecting the catheter to the dialysate bag in the non-disconnecting system

T-set
A variant of the double-bag system, which consists of a catheter extension equipped with a very short lateral limb, through which, at the end of the exchange, before the disconnection of the bag, a disinfectant is injected filling the catheter extension.

Tunnel infection
Erythema, edema or tenderness or any combination of these over the subcutaneous portion of the catheter

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U

Ultrafiltrate
In peritoneal dialysis, the net amount of fluid resulting when the original volume of the dialysate used for a certain dwell is subtracted from the volume of the drained dialysate(effluent-infused dialysate = ultrafiltrate).

Ultrafiltration

The process by which plasma water is removed from the blood related to an osmotic pressure gradient. The rate of ultrafiltration is highest in the beginning of an exchange when the osmotic gradient is highest.

Ultrafiltration failure
The inability of the peritoneal membrane to provide adequate ultrafiltration.

Universal Precautions

Those necessary safeguards based upon the assumption that all human blood and certain human body fluids are treated as if they are known to be infectious for any blood borne pathogens.

Urea

Waste products formed by the breakdown of protein in the body.

Uremia

Toxic condition that develops in kidney failure due to the accumulation of waste products in the blood that are normally excreted in the urine.

Uremic Frost

A white, powder-like substance that results from the precipitation of urea crystals secreted in the sweat. It may be seen on the face and trunk. Unusual to see today as dialysis usually begins before this develops.

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V

Vein

Blood vessel that carries deoxygenated blood toward the heart from other parts of the body.

Venous Drip Chamber
Chamber within the hemodialysis extracorporeal circuit where venous pressure is monitored.  A bubble trap inside the drip chamber collects any air that enters the blood tubing.

Venous Pressure
The pressure within the venous drip chamber of the hemodialysis extracorporeal circuit.

Vomiting
The forcible expulsion of the contents of the stomach through the mouth.

Vital Signs

Blood pressure, temperature, pulse and respiration.

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References:

1. Liakopoulos V, Stefanidis I, Dombros VN. Peritoneal dialysis glossary 2009. Int Urol Nephrol. Published online Sept 17, 2009

2. Witowski J, Jörres A, Korybalska K, Ksiazek K, Wisniewska-Elnur J, Bender TO, Passlick-Deetjen J, Breborowicz A. Glucose degradation products in peritoneal dialysis fluids: Do they harm?. Kidney Int 63: S148–S151, 2003

3. Gotch F, Sargent JA. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int 28:526-534, 1985



A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z



AAMI
Association for the Advancement of Medical Instrumentation that develops voluntary standards for aspects of dialysis, including water treatment and dialyzer reprocessing.

Acid Clean
Pertaining to a hemodialysis system: A daily process where acid (vinegar) is rinsed through the acid and bicarbonate lines.

Acidosis
A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate) content of the blood and body tissues, and characterized by an increase in hydrogen ion concentration (decrease in pH).

Acute
Rapidly developing; severe; short duration.

Acute Renal Failure

A sudden loss of kidney function; it can be reversible.

Air Embolism
Occurs when air bubbles enter the bloodstream and are carried into a vessel small enough to be blocked by the air, where it acts like a clot, blocking the flow of blood.

Alkalosis
A pathological condition resulting from accumulation of bicarbonate and is characterized by a decrease in hydrogen ion concentration and increase in pH.

Allergic Reaction
Local or general hypersensitivity reaction following contact with a specific allergen.

Ambulatory
Moving or walking around.

Anaphylaxis

Anaphylaxis or anaphylactic reaction is an immediate, severe reaction to a substance to which an individual is allergic. The reaction may include signs and/or symptoms such as hives, itching or wheezing. The reaction may develop into anaphylactic shock, which can cause life-threatening consequences such as hypotension, cardiac arrhythmias or arrest, spasms of the breathing passages and swelling of the throat.

Anemia

A deficiency of the oxygen carrying pigment of hemglobin often accompanied by a reduced number of circulating red blood cells; common in patients on dialysis due to decreased red blood cell production and procedural blood loss. The major symptoms are fatigue, tiredness, breathlessness on exertion, pallor and poor resistance to infection.

Anticoagulant
Substance that delays or prevents coagulation of blood.

Antiseptic

A chemical which prevents or inhibits growth and reproduction of bacteria; it does not necessarily destroy them as a disinfectant would.

Anuric

Absence of urine formation.

Arrhythmia
Irregular heart beat, rapid or slow pulse, palpitations caused by changes in the blood pH or electrolyte levels (potassium), hypotension or heart disease.

Arterial Drip Chamber
Chamber within the hemodialysis system extracorporeal circuit were arterial pressure is monitored.  A bubble trap inside the drip chamber collects any air that enters the blood tubing.

Arterial line
Part of the hemodialysis system extracorporeal circuit that is involved with transporting the patient’s blood to the dialyzer.

Arterial Side of Dialyzer
The end of the dialyzer where the patient’s blood enters to be dialyzed.

Aseptic

Free from infectious organisms; sterile.

Aseptic Technique

A process of rendering an object completely free of microorganisms. A method usually involving sterile gloves, gowns and masks.

Assisted PD
The administration of peritoneal dialysis (PD) modalities to a physically dependent patient by a home-visiting nurse, a caregiver or a family member.

Auto Flow Rate
A ratio of dialysate flow to blood flow based on the dialysis prescription, for example 2x dialysate auto flow with a blood flow of 400ml/min would be 800 ml/min.

Automated PD (APD)
A number of different PD modalities that use an automated peritoneal dialysis (PD) machine.

Automated PD machine
An electrical appliance specifically designed to perform peritoneal dialysis (PD) automatically, also known as a "cycler".

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B


Back Pain
Pain or discomfort located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions.

Bacteria
Single cell organisms, fully capable of rapid reproduction. They are prevalent everywhere; some are harmless, others known to produce infectious diseases.

Bicarbonate
A buffer used by the body to neutralize acids that form when the body breaks down protein and other foods. 

Biocompatibility
The quality of not having toxic or injurious effects on biological systems.

Biocompatible PD solutions
Peritoneal dialysis (PD) solutions with characteristics like low GDP concentration, near neutral pH, low concentration of lactate buffer (some biocompatible solutions use bicarbonate as a buffer and others use a mixture of bicarbonate and low lactate concentrate).

Blood Circuit
Component of the hemodialysis system that is enclosed within the arterial blood line, dialyzer fibers and the venous blood line. It is also referred to as the extracorporeal circuit.

Blood Flow Rate
See blood pump speed.

Blood Leak Detector
An alarm system that monitors used dialysate for blood or air that would indicate a leak in the dialyzer membrane.

Blood Line Set
Part of the extracorporeal circuit that carries blood from the patient’s vascular access through the arterial needle or catheter port, to the dialyzer, and back to the patient through the venous needles or catheter port.  There are two segments of blood tubing: arterial (red connector colored) and the venous (blue connector colored).  Other components of the blood tubing include patient connectors, dialyzer connectors, arterial and venous drip chambers, blood pump segment, heparin and saline infusion lines.

Blood Pressure

The pressure exerted against vessel walls resulting from the pumping force of the heart and resistance of blood vessels. It is measured by auscultating (listening to) the changing sounds produced by varying external pressures on an artery.

Blood Protein

A complex substance or very large nitrogen containing molecule found in blood.

Blood Pump
Part of the hemodialysis delivery system that moves the patient’s blood through the extracorporeal circuit at a fixed rate of speed when the blood pump segment is threaded between the pump head and the rollers.

Blood Pump Door
Cover of the blood pump.

Blood Pump Housing
Component of the hemodialysis machine that holds the blood pump rotor and tubing guides.

Blood Pump Speed
Prescribed rate of blood programmed on the blood pump.

Body Mass Index (BMI)

Anthropometric index defined as weight in kilograms/(stature in m2)2.

Bolus
A relatively large, single dose.

BUN (Blood Urea Nitrogen)
Nitrogen in the blood in the form of urea. It is a result of protein breakdown due to dietary intake (digestion) or inherent bodily tissue breakdown. An increase usually indicates decreased kidney function.

Bypass Mode
Bypass mode occurs when the dialysate conductivity or temperature goes outside alarm limits.  In bypass mode, valves inside the hemodialysis machine redirect the flow of dialysate to bypass the dialyzer internally until temperature and conductivity are back within acceptable limits.

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C

Cardiac Tamponade
A pathological condition which results from excess accumulation of fluid in the pericardium.

Catheter

A tubular, flexible instrument, passed through body channels for withdrawal of fluids from (or introduction of fluids into) a body cavity.

Catheter extension
A piece of tubing connecting the catheter to the peritoneal dialysis (PD) delivery system.

Catheter-related peritonitis (or exit site- or tunnel infection-related peritonitis)
A peritonitis episode in conjunction with an exit-site or tunnel infection with the same organism as that at the exit site.

Chemoreceptor

A sense organ or sensory nerve ending that is stimulated by and reacts to certain chemical stimuli. It is located outside of the central nervous system.

Chemical Rinse
The “Chemical/Rinse program of the hemodialysis machine disinfects the machine by rinsing it with water, chemical disinfectant, and water again. 

Chest Pain
Pressure, burning, or numbness in the chest.

Chronic

Of long duration or recurring frequently.

Chronic Kidney Disease

Persistent, long-lasting renal pathologic process, often associated with loss of kidney function.

Chronic Renal Failure

The progressive, irreversible loss of kidney function that occurs over periods of time ranging from a few months to decades. Also called Chronic Renal Insufficiency.

Clean Technique

Rendering an object partially free from organisms.

Clean Technique
Series of steps necessary to prevent contamination of patient or environment. It includes, but is not limited to, using clean gloves and hand washing.

Clearance

A quantitative measure, expressed in mL/minute, of the rate at which waste products are removed from the blood by the kidney, peritoneal membrane or artificial kidney.

Clot

A mass of coagulated blood. The normal reaction of the blood to a damaged blood vessel or foreign material.

Coagulation

The process of forming a blood clot.

Coefficient

A numerical measure of a physical or chemical property that is constant for a system under specified conditions.

Concentrate
Pertaining to hemodialysis: One of two salt solutions (acid and bicarbonate) that are mixed together with purified water to form dialysate.

Conductivity
The ability of a fluid to transfer electrical charge as a measurement of ions in a solution.

Conductivity Meter
Measures the electrolyte composition of dialysate to ensure it is within safe limits for use.

Connecting device
A device of different designs (exclusively specific for each peritoneal dialysis (PD) delivery system) used for the connection of the catheter or its extension to the delivery sytem. Synonym to connector.

Contaminate

To make unclean, unsterile or impure.

Continuous ambulatory peritoneal dialysis (CAPD)
A peritoneal dialysis (PD) modality where a certain amount of dialysate is always present in the peritoneal cavity resulting in a continuous dialysis method. Four daily exchanges are typically performed manually using gravity or in some cases with the use of an assisting device.

Continuous cycling peritoneal dialysis (CCPD)
An automated PD (APD) modality with a number of exchanges during the night and a long daytime dwell. All exchanges are performed by a cycler.

Continuous cycling peritoneal dialysis plus or enhanced(CCPD plus or enhanced CCPD)
Continuous cycling peritoneal dialysis (CCPD) with the addition of at least one daytime manual exchange.

Continuous flow peritoneal dialysis(CFPD)
A peritoneal dialysis (PD) modality where dialysate flows continuously in and out of the peritoneal cavity through two separate catheters or one dual lumen catheter.

Contraindication
Symptom, condition or circumstance that renders the use or a remedy or procedure inadvisable, usually because of a risk.

Convulsion
Violent involuntary contraction or series of contractions of voluntary muscles. Also known as seizure.

Corrosive
Slow disintegration or wearing away of something by a destructive agent.

Cramping
During the hemodialysis treatment: Painful muscle cramps often in the hands and feet resulting from removal of too much fluid, changes in blood chemistry, especially sodium, low potassium levels and hypotension.

Creatinine

Creatinine is a waste product of creatinine phosphate metabolism, which is found especially in the muscle and blood. Increased creatinine values in the blood can be an indication of renal failure. It is one of the primary lab values indicating a patient's need to start dialysis.

Crenation
Conversion of normally round red blood cells into shriveled, irregularly shaped forms that occurs if the blood is exposed to a solution that is more concentrated than blood.

Culture negative peritonitis
The appearance of cloudy effluent (with more than 50% polymorphonuclear white blood cells) and abdominal pain with persistently (>3) negative cultures of peritoneal effluent.

Cycle

A peritoneal cycle or exchange is the infusion and drainage of a specific volume of peritoneal dialysis solution consistent with the PD prescription. The PD prescription defines the volume, dwell time and sometimes the rate of infusion and drainage. The dwell time may vary from a few minutes to several hours.

Cycler

A machine used to infuse and drain dialysate from the peritoneal cavity.

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D

Dehydration
Excessive water loss from the body, organ or bodily part. This occurs when output of water exceeds intake.

Dextrose (Glucose)
A form of sugar used in dialysate to remove fluid.

Dialysate (dialysis fluid)

A mixture of water, electrolytes and dextrose. Sodium lactate is the most commonly used buffer in the dialysis solution. Newer solutions using pure bicarbonate or bicarbonate/lactate combinations have been developed as a more physiological buffer. Electrolyte levels in dialysate are proportioned to ensure that the levels in the blood remain within physiological range. Waste products, such as BUN and creatinine are not present in the dialysate and will readily move out of the blood into the dialysis fluid.

Dialysate Circuit
Component of the dialysis system that is enclosed within the hydraulic system and the dialysate compartment (outside the fibers) of the dialyzer.

Dialysate container
In peritoneal dialysis: The bag containing the dialysate, also known as the “peritoneal dialysis bag”.

Dialysate Flow Rate
A prescribed ml/min flow of the dialysate through the dialyzer.

Dialysate fresh
The unused dialysate

Dialysate leak (peritoneal)
Extravasation of the fluid to any space outside the peritoneal cavity (e.g. pleural cavity, through the exit site or the surgical incision, scrotum).

Dialysate spent
The dialysate drained out after its dwell in the peritoneal cavity, also known as effluent.

Dialysis

Diffusion of blood across a semi-permeable membrane to remove toxic substances. Dialysis maintains fluid, electrolyte and acid-base balance when there is impaired kidney function or there are no native kidneys.

Dialyzer Reaction
Can be caused by a reaction to ethylene oxide with symptoms occurring in the first 15 – 30 minutes of treatment that include itching, chest and or back pain, shortness of breath, hypotension, nausea and general discomfort.

Diastolic Blood Pressure

The blood pressure against the arteries when the heart is at rest (between beats). It is the bottom half of the blood pressure reading.

Diffusion

Process in which solutes move from an area of high solute concentration through a semi-permeable membrane to an area of low solute concentration.

Disequilibrium Syndrome
Can occur when the BUN is removed much faster from the blood than from the brain, when disequilibrium occurs, fluid moves into the brain cells and potential symptoms are headache, nausea, hypertension, restlessness, confusion, blurred vision and seizures. 

Disinfectant

Chemical that destroys bacterial-organisms.

Distal

Refers to furthest from the center of the body. For example, the hands and feet are distal extremities. The opposite of proximal.

Diurnal PD or daytime PD
A number of manual exchanges during the day with a dry abdomen during the night (for those who need short exchanges and for whatever reason cannot or will not use a cycler).

Drain (of PD fluid)
The action of outflow of the spent dialysate from the peritoneal cavity.

Drain Time
The amount of time needed for the peritoneal fluid to drain from the peritoneal cavity.

Drip Chamber
Used to collect air in the arterial and venous chambers of the hemodialysis system.

Dry Weight

The ideal body weight without excess fluid volume.

Dwell
The period during which the dialysate remains inside the peritoneal cavity (usually from the end of the infusion to the beginning of drainage).

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E

Edema
Accumulation of an excessive amount of fluid in or around tissues or cells.

Effective peritoneal surface area
The area of the peritoneal surface that is sufficiently close to peritoneal capillaries to play a role in solute and water transport.

Efferent
Carrying away from the central organs or section. For example, efferent arterioles carry blood away from the glomeruli of the kidney. The opposite of afferent.

Effluent

The used or spent dialysate fluid that is carried to the drain.

Electrolytes

An electrolyte is a compound that breaks apart into ions. Common electrolytes include sodium (Na+), potassium (K+) and calcium (Ca++). Electrolytes transport electrical impulses along the nerves to the muscles, including the heart. Healthy kidneys maintain electrolyte balance in the body. Electrolytes are added to dialysate in carefully controlled amounts.

Embolus

A mass of undissolved matter present in the blood or lymph brought there by the blood or lymph current.

Encapsulating peritoneal sclerosis (former term: Sclerosing encapsulating peritonitis)
A life threatening complication of peritoneal dialysis where an encapsulating sclerotic reaction of the peritoneum develops, with the bowel enveloped in a thick cocoon of fibrous tissue, causing intermittent,partial, or complete bowel obstruction.

Endotoxin

A poison harmful to all body tissues, contained within certain Gram negative bacteria and released only when the bacterial cell is broken down or dies and disintegrates.

End Stage Renal Disease

Term used for complete or irreversible loss of kidney function, the last stage of chronic renal failure. Also referred to as ESRD.

Enteric peritonitis
Infectious peritonitis with an organism consistent with those from the gastrointestinal tract. (Presence of anaerobic organisms is pathognomic of this condition).

Equilibrium

The body's attempt to maintain balance or homeostasis. Used in reference to equal concentrations in two compartments across a semipermeable membrane.

Erythropoietin

A hormone that acts on the bone marrow to stimulate red blood cell production. It is produced by the kidney in response to oxygen deficiency in the tissues.

Estimated Dry Weight

The weight the patient would be if the kidneys functioned normally.

Etiology

The cause of a disease.

Exchange

A peritoneal exchange or cycle is the infusion and drainage of a specific volume of peritoneal dialysis solution consistent with the PD prescription. The PD prescription defines the volume, dwell time and sometimes the rate of infusion and drainage. The dwell time may vary from a few minutes to several hours.

Exit site
The most external part of the sinus tract and the skin surrounding the exit of the catheter tunnel. Usually the location of the exit site is in the abdominal wall, but a presternal exit site is also an option.

Exit-site infection
Evidence of inflammation (pain, swelling, erythema, and/or discharge) at the exit site.

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F

Febrile
Body temperature greater than 98.6F or 37.0C.

Fibrin

A whitish filamentous protein formed by the action of thrombin on fibrinogen.

Fill
Term used in peritoneal dialysis to indicate the action of inflow of the fresh dialysate from its container into the peritoneal cavity.

Filtration
Process of a stream of liquid moving through a partition with small holes. Fluid and particles small enough to pass through the partition will, while larger particles will remain.

Flush
Peritoneal flush or lavage is the "rapid" infusion and drainage of peritoneal dialysis solution with the purpose of removing blood, fibrin, debris or spent dialysate from the peritoneal cavity or catheter. The dwelltime is minimal or non-existent. Or, in terms of the actual exchange procedure itself, to flush is to remove the remaining air from the infusion line into the drainage bag.

Fluid Overload
State of the patient when dry weight has not been reached, this can lead to congestive heart failure or pulmonary edema.

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G

Glomerular Filtration Rate (GFR)

The volume of plasma filtered from the glomerular capillaries into the Bowman's capsule each minute (mL/min).

Glomerulus

A cluster of capillary blood vessels that act as a filter in the nephron.

Glucose degradation products (GDPs)
Products resulting from the degradation (break down) of glucose during heat sterilization of the dialysate, which are believed to be toxic to the peritoneal membrane. Glucose can bind in a non-enzymatic way to amino residues forming a Schiff base and later a reversible Amadori glycosylation product.  These products undergo rearrangements over time and form irreversible advanced glycation end products (AGEs), which may play a role in the development of peritoneal fibrosis and microvascular sclerosis, observed in long term PD patients. Formation of GDP can be significantly reduced by the use of multi-chamber bag systems2

Gram
The basic unit of weight measure in the metric system. There are approximately thirty grams in one ounce.

Gross peritoneal surface area
The anatomical surface area of the peritoneal membrane lining the peritoneal cavity.

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H

Hand Crank
Relating to the hemodialysis machine:  Method used to return blood to the patient during a power failure, also know as Emergency Hand Crank, that utilizes the auxiliary blood pump crank handle inserted into the hand crank spindle on the blood pump and the blood is manually returned to the patient.

Headache
Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions.

Hemastix
Monitoring strip that identifies the presence of blood.

Hematocrit
A measurement of red cells in the blood, stated as a percentage of red blood cells per total blood volume.

Hematoma

An accumulation of blood that has escaped into the tissues from blood vessels. It is commonly referred to as a bruise and appears "black and blue".

Hemodialysis

A process of removing chemical substances and water from the blood by passing it through an artificial kidney composed of semi-permeable membranes.

Hemoglobin

Protein found in erthrocytes that transports oxygen in the blood.

Hemolysis

The destruction of red blood cells resulting in the liberation of haemoglobin, potassium and other cell contents.

Hemorrhage

Abnormal bleeding, either internal or external.

Heparin

A powerful anticoagulant that blocks/suppresses clotting of the blood. In peritoneal dialysis heparin can be added to the dialysis solution. Heparin inhibits the formation of fibrin and may prevent subsequent adhesion formation.

Heparin Pump
A component of the hemodialysis delivery system that delivers heparin at a prescribed rate.

Hepatitis

An inflammation of the liver, can be of viral or toxic origin.

Homeostasis

State of equilibrium of the internal environment of the body that is maintained by dynamic processes of feedback and regulation.

Hydrostatic Pressure

The pressure exerted by a column of water due to gravity or mechanical pressure.

Hyperkalaemia

Unusually high levels of potassium in the blood.

Hyperparathroidism
Primary hyperparathyroidism is a disorder of the parathyroid glands, also called parathyroids. "Primary" means this disorder originates in the parathyroids: One or more enlarged, overactive parathyroid glands secretes too much parathyroid hormone (PTH). In secondary hyperparathyroidism, a problem such as kidney failure causes the parathyroids to be overactive.

Hypertension

Blood pressure greater than normal.

Hyperthermia
Abnormally high body temperature.

Hypertrophy

An increase in size of an organ or structure that does not involve tumor formation.

Hypervolemia
Abnormally increased volume of circulating blood in the body.

Hypokalaemia

Not enough potassium in the blood.

Hypotension

Low blood pressure.

Hypoperfusion

Decreased blood flow through an organ, as in circulatory shock. If prolonged, it may result in permanent cellular dysfunction and death.

Hypothermia
Abnormally low body temperature.

Hypotonic

A solution with an osmolality or concentration of solutes less than that which it is compared. In dialysis, the fluid of comparison is usually blood.

Hypovolemia
Abnormally decreased volume of circulating blood in the body.

Hypoxia
Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen.

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I

Icodextrin
Usually a 20 glucose polymer molecule which is used as an agent inducing ultrafiltration by oncotic pressure. [From the Greek word for twenty: eicosi or ico(si) + dextrin = icodextrin].

Infection
Invasion of the body by disease producing organisms and the reaction of the tissues to their presence.

Infiltration
In hemodialysis, this is referred to as the dislodgment of the fistula needle from the patient’s access which results in blood being returned to the surrounding tissues.

Inflow time
The time needed for the fresh dialysate to enter the peritoneal cavity.

Intermittent peritoneal dialysis (IPD)
IPD generally consists of frequent, short cycles performed over 8 - 10 hours per session, three times weekly. The peritoneal cavity remains drained between sessions. If IPD is practiced on a nightly basis, it is referred to as nocturnal IPD (NIPD). See home page “peritoneal dialysis-modalities”.

Intraperitoneal Volume (Vip)

The volume of fluid inside the peritoneal cavity.

Isotonic

A solution with an osmolality or concentration of solutes equal to that which it is compared. In dialysis, the fluid of comparison is usually blood.

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K

Kilogram
1,000 grams; 2.2 pounds.

Kt/V
The Kt/V concept was introduced by Gotch and Sargent to quantitate dialysis dose and represents the product of urea clearance (K) and dialysis time (t) divided by the volume of distribution of urea or total body water (V)3.  Kt/V is different in hemodialysis (HD) compared to peritoneal dialysis (PD).  In HD, Kt/V relates to a single dialysis session, whereas in PD Kt/V relates to an entire week.

KUF
In vivo ultrafiltration constant.  The fixed amount of fluid a dialyzer will remove from the patient’s blood per hour at a specified pressure. A dialyzer’s KUF is included with its instructions.

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L

Lavage
Peritoneal lavage or flush is the "rapid" infusion and drainage of peritoneal dialysis solution with the purpose of removing blood, fibrin, debris or spent dialysate from the peritoneal cavity or catheter. The dwell time is minimal or non-existent.

Luer lock
A type of tubing connector with threaded fittings for a secure connection and added leverage for a seal disconnect. The concept for these adapters was developed by Hermann Wulfing Luer, a German medical instrument maker whose name still defines this unique design.

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M

Mass transfer area coefficient (MTAC)
For a given solute, MTAC is equivalent to the diffusive clearance of that solute per time unit in a theorectical situation where dialysate flow in infinitely high, so that the solute gradient is always maximal (MTAC is analogous to K0A of a hemodialysis membrane and is best assessed at the beginning of each exchange when there is maximum difference in the concentration between blood and dialysate)

Macrophage

A large scavenger cell present in connective tissue and many major organs and tissues including the bone marrow, spleen, lymph nodes, liver and central nervous cells.

Membrane

A thin layer of tissue that covers or surrounds a surface or space. In dialysis,it can refer to either the peritoneal membrane or the material out of which the internal fibres of the artificial kidney are composed.

Membrane failure
The inability of the peritoneal membrane to maintain adequate ultrafiltration or adequate solute clearance.

Metabolism

The sum of all physical and chemical changes that take place within an organism. All energy and material transformations that occur within living cells.

Modality
A means or manner in which a procedure is attained.

Molecule
Smallest particle of a substance with distinct chemical properties that identify the substance; stable group of atoms.

Morbidity
Pertaining to disease or illness.

Mortality

Pertaining to death or loss of life.

Myalgia

Tenderness or pain in the muscles.

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N

Nausea
An unpleasant sensation in the stomach usually accompanied by the urge to vomit.

Nephritis

Inflammation of the kidney. A disease of the kidneys haematuria associated with a nephritic syndrome that includes hematuria as its distinguishing component. Other classic symptoms include hypertension, renal insufficiency, volume overload, oedema, and in some cases, proteinuria.

Nephrologist

A physician who specializes in kidney diseases and their treatment.

Nephron

The structural and functional unit of the kidney. It consists of a glomerulus enclosed within Bowman's capsule and its attached tubule (consists of proximal convoluted tubule, loop of Henle and distal convoluted tubule). Urine is formed by filtration in the glomerulus, and selective reabsorption and secretion by cells of the renal tubule.

Net sieving coefficient
The fraction of extracellular solute volume removed per unit of ultrafiltrate volume.

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O

Occlude

To shut or close off.

Oedema
Excess fluid in the body tissues; swelling of the body due to excess fluid.

Oliguria
Decreased amount of urine formation.

Osmolality

The osmotic concentration characteristic of a solution that is determined by the ionic concentration of the dissolved substance per unit of solvent.

Osmolarity

The concentration of osmotically active particles in solution.

Osmosis

Passage of fluid through a semi-permeable membrane from an area of lesser concentration to an area of greater concentration in order to achieve equilibrium of solute.

Osteitis Fibrosa Cystica

Tissue level lesions, fibrosis of the marrow spaces and abundance of osteoclasts. Is characterized by severely increased bone resorption and high levels of parathyroid hormone (PTH).

Outcome

End product or result.

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P

Palpable

Perceptible to touch.

Palpitation

Irregular beating of the heart.

Pericarditis

Inflammation of the pericardium, or sac surrounding the heart.

Pericardial Effusion

Fluid in the pericardial cavity, between the visceral and parietal pericardium. It may produce symptoms of cardiac tamponade (see above for definition).

Peritoneal catheter cuff
A band of fabric (e.g. Dacron) affixed to the intratunnel part of the catheter leading to pericatheter fibrous tissue growth. Usually, peritoneal catheters have two cuffs, one located close to the endoabdominal fascia (deep or epiperitoneal or inner or internal cuff) and the other located close to the skin (outer or subcutaneous or superficial or external cuff).

Peritoneal catheter tunnel
The passageway through the abdominal wall within which the peritoneal catheter is contained.

Peritoneal dialysis catheter
See catheter. The intraperitoneal and the extraperitoneal potions differ in various catheters. The most commonly used type of catheter is the Tenckhoff catheter (straight, coiled, or swan-neck design). Modifications of the Tenckhoff catheter are the Missouri swan-neck catheter, the Moncrief-Popovich swan-neck catheter and the Toronto Western Hospital (TWH) or Oreopoulos-Zellerman catheter.

Peritoneal dialysis connectology
A conventional term referring to the various systems of transfer sets, connecting devices, containers, adapters, etc., which are used during the process of peritoneal dialysis.

Peritoneal dialysis dose
The amount of dialysate used in a specified time. It can be numerically expressed by Kt/V or creatinine clearance and should be corrected to either the total body water or body surface area.

Peritoneal dialysis prescription
The combination of peritoneal dialysis modality, dose and schedule.

Peritoneal dialysis (PD) training
The procedure of preparing an individual with ESRD for the self administration of the PD treatment, including preparation of materials, aseptic technique, prevention of contamination, exit site care, performing exchanges, troubleshooting, record keeping, and ordering supplies. PD training is usually provided by a specially trained nurse.

Peritoneal eosinophilia (Former term: Eosinophilic peritonitis)
Asymptomatic cloudy effluent with more than 15% eosinophils in a differential WBC count. It usually appears in the first few months after starting PD and is usually a benign self-limiting condition. (Peritoneal eosinophilia can also occur later during some fungal infections).

Peritoneal equilibration test (PET)
See http://www.advancedrenaleducation.com/PeritonealDialysis/PeritonealTransport/UnderstandingTestingMethods/tabid/80/Default.aspx.

Peritoneal sclerosis
The extensive thickening of the peritoneal membrane due to fibrous tissue and new vessel formation, usually as a result of long-term PD, especially when the latter is complicated by severe or recurrent peritonitis.

Peritonitis

Peritonitis is an inflammation of the peritoneum. Infectious peritonitis is inflammation of the peritoneum related to microorganisms. Resistant or refractory peritonitis is an episode that does not respond to treatment within 48 hours. Relapsing peritonitis is an episode that initially responds to treatment but then symptoms reappear. Recurrent peritonitis is an episode with symptoms that return within 2 weeks of the completion of therapy for peritonitis and the organism is the same as in the prior episode.

pH
The hydrogen ion concentration of a solution.  A solution with a pH above 7 is alkaline (base).  A solution with a pH below 7 is an acid.

Phosphate Binder

Compounds that bind phosphorus in the GI tract, preventing absorption. Bound phosphorus becomes part of the faeces and is eliminated. Classes of binders include aluminum, calcium and magnesium as well as non-absorbable calcium and aluminum-free compounds.

Phosphorus
Is a nonmetallic element present in such foods as dairy products, meats, fish, nuts, chocolate and cola.  Too much phosphorus in the blood can cause itching, secondary hyperparathroidism and bone disease.

Plasma

The straw coloured, non-cellular liquid portion of the blood containing clotting factors. It consists of water, electrolytes, nutrients and proteins.

Polyglucose
Mixture of glucose polymers in different chain lengths.

Pore

Small opening or hole.

Postural Hypotension

The development of hypotension when the posture is changed. This is usually manifested by dizziness on standing.

Potassium
A metallic element, and an important electrolyte in the human body,  Levels of potassium that are too high or too low can cause illness or death, levels must be kept within very tight limits.

Prescription
Directions written for the preparation and administration of a therapy.

Prime
Procedure done before hemodialysis to remove air from the extracorporeal circuit by flushing the bloodlines and dialyzer with saline.

Protein

A group of nitrogen-containing compounds found widely in nature in both plants and animals. They are formed from complex combinations of amino acids. They form structural material of muscles, tissues and organs. They form enzymes and hormones.

Proximal

Nearest the point of attachment, centre of the body or point of reference. Opposite of distal.

Pruritis

Intense itching.

Pulmonary Oedema

An accumulation of fluid in the lungs caused by fluid overload.

Pulse

Rhythmical throbbing caused by the regular expansion and contraction of an artery.

PVC

Abbreviation for polyvinyl chloride

Pyrogen

A substance that causes fever.

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R

Recurrent peritonitis
A peritonitis episode that occurs within 4 weeks of completion of therapy of a prior episode but with a different organism.

Red Blood Cell (RBC)

Cells in the blood stream that carry oxygen in a complete molecule called haemoglobin.

Refractory peritonitis
Failure of the effluent to clear after 5 days of appropriate antibiotic therapy

Regimen

A regimen is a systematic plan of therapy that is generally characterized as intermittent or continuous when referring to the duration of dialysis, and supine or ambulatory when referring to the position of the patient (for PD).

Relapsing peritonitis

A peritonitis episode that occurs within 4 weeks of completion of therapy of a prior episode of peritonitis with the same organism or a prior sterile episode.

Renal
Pertaining to the kidneys.

Renal Osteodystrophy

Generalized bone disease resulting from metabolic disorder caused by renal failure.

Repeat peritonitis
A peritonitis episode that occurs more than 4 weeks after completion of therapy of a prior episode with the same or different organism.

Restless Leg Syndrome
Is a condition that is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso.

Reverse Osmosis (RO)

A method for purifying water by forcing it through a semi-permeable membrane that prevents the passage of ions.

Rinse Back Volume
Amount of saline required to rinse the patient’s blood back following completion of the hemodialysis treatment.

Rotor
The rotating part of an electronic or mechanical device.

Rx
Abbreviation for "Prescription".

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S

Semi-permeable Membrane

A membrane with pores that are permeable to some (smaller molecules) but not to larger molecules.

Sequential Dialysis
Two-stage form of hemodialysis treatment in which the first stage consists only of ultrafiltration.  In the first stage, there is no dialysate flow while the ultrafiltration pump draws excess fluid from the patient.  After the calculated amount of fluid has been drawn, usually a standard dialysis treatment, begins.

Shock

Extreme hypotension.

Sphygmomanometer

An instrument used to measure blood pressure.

Sodium
Chief cation of the extracellular body fluids. Its salts are the most widely used in medicine.  Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance.

Solute

The substance that is dissolved in a liquid (solvent) to form a solution.

Standard Kt/V

The stdKt/V is a formula to measure the relative efficiency of the whole spectrum of dialytic therapies whether intermittent, continuous or mixed.  This method allows the measurement of clearance efficiency of HD of variable frequency, continuous PD, intermittent PD, slow continuous renal replacement therapies (CRRT), residual renal function (RRF) and all situations involving the use of clearance from various methods.

Steal Syndrome
Pain or weak pulse in affected limb caused by shunting of normal arterial blood supply through the access thus depriving distal extremity of needed oxygenation.

Sterile
Completely free from living microorganisms.

Sterile peritonitis
Synonym to culture-negative peritonitis

Stethoscope

A device used to auscultate (listen to) sounds produced by the body. It consists of rubber tubing connecting two ear pieces to a diaphragm and/or bell.

Supine position

Lying with the face upward, or on the dorsalsurface.

Syringe
Instrument used for injecting or withdrawing fluids.

Systolic Blood Pressure

This is the pressure inside arteries during a heartbeat. This is the top half of the blood pressure reading.

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T

Tachycardia

An abnormally fast heart rate. If 70 to 90 beats per minute is considered normal, then 100 beats per minute would indicate tachycardia.

Technique

A technique is the procedure by which a regimen is accomplished.  These definitions can be confusing since similar terms are applied to the regimen and the technique.

Technique failure rate
The proportion of peritoneal dialysis patients switching to hemodialysis

Three-pore model
A theoretical model describing solute and water transport across the peritoneal membrane
Proposing the presence of three different sizes of pores. The smallest are considered to be the aquaporins.

Tetany
A set of symptoms which include intermittent tonic spasms, nervousness and muscular irritability induced by changes in calcium or pH.

Thrombus

Clot formed in a blood vessel or blood passage.

Tidal peritoneal dialysis
See http://www.advancedrenaleducation.com/PeritonealDialysis/ModalitiesofTherapy/PDModalities/tabid/83/Default.aspx

Titanium (or plastic) adaptor
The Luer lock adaptor made of titanium (or plastic), connecting the catheter to its extension or to the administration set of a double-bag system.

TMP (Transmembrane Pressure)
The difference in pressure between the filtrate and permeate sides of the dialyzer membrane.  TMP = Venous Pressure – Dialysate Pressure.

Transducer
An electronic sensor in the hemodialysis  machine that reads the pressure inside the arterial and venous drip chambers.  Transducers are connected to the drip chambers through pressure monitor lines.

Transfer set
The tubing connecting the catheter to the dialysate bag in the non-disconnecting system

T-set
A variant of the double-bag system, which consists of a catheter extension equipped with a very short lateral limb, through which, at the end of the exchange, before the disconnection of the bag, a disinfectant is injected filling the catheter extension.

Tunnel infection
Erythema, edema or tenderness or any combination of these over the subcutaneous portion of the catheter

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U

Ultrafiltrate
In peritoneal dialysis, the net amount of fluid resulting when the original volume of the dialysate used for a certain dwell is subtracted from the volume of the drained dialysate(effluent-infused dialysate = ultrafiltrate).

Ultrafiltration

The process by which plasma water is removed from the blood related to an osmotic pressure gradient. The rate of ultrafiltration is highest in the beginning of an exchange when the osmotic gradient is highest.

Ultrafiltration failure
The inability of the peritoneal membrane to provide adequate ultrafiltration.

Universal Precautions

Those necessary safeguards based upon the assumption that all human blood and certain human body fluids are treated as if they are known to be infectious for any blood borne pathogens.

Urea

Waste products formed by the breakdown of protein in the body.

Uremia

Toxic condition that develops in kidney failure due to the accumulation of waste products in the blood that are normally excreted in the urine.

Uremic Frost

A white, powder-like substance that results from the precipitation of urea crystals secreted in the sweat. It may be seen on the face and trunk. Unusual to see today as dialysis usually begins before this develops.

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V

Vein

Blood vessel that carries deoxygenated blood toward the heart from other parts of the body.

Venous Drip Chamber
Chamber within the hemodialysis extracorporeal circuit where venous pressure is monitored.  A bubble trap inside the drip chamber collects any air that enters the blood tubing.

Venous Pressure
The pressure within the venous drip chamber of the hemodialysis extracorporeal circuit.

Vomiting
The forcible expulsion of the contents of the stomach through the mouth.

Vital Signs

Blood pressure, temperature, pulse and respiration.

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References:

1. Liakopoulos V, Stefanidis I, Dombros VN. Peritoneal dialysis glossary 2009. Int Urol Nephrol. Published online Sept 17, 2009

2. Witowski J, Jörres A, Korybalska K, Ksiazek K, Wisniewska-Elnur J, Bender TO, Passlick-Deetjen J, Breborowicz A. Glucose degradation products in peritoneal dialysis fluids: Do they harm?. Kidney Int 63: S148–S151, 2003

3. Gotch F, Sargent JA. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int 28:526-534, 1985

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